How do countries in the vast and diverse Asia-Pacific region differ in “prescribing cultures”? How do health systems in the region balance access to pharmaceuticals with incentives for innovation? How do the forces of globalization shape, and in turn are shaped by, cultural legacies about health and health care? These are the key questions addressed by the new Asia Health Policy Program book, Prescribing Cultures and Pharmaceutical Policy in the Asia Pacific.

AHPP held a book launch event September 23rd with three authors of the book detailing how pharmaceutical policies are interlinked globally and at the same time deeply rooted in local culture. 

The coming to power of a new party in Japan, with a strong mandate to rule, is unprecedented in the postwar era. In the aftermath of the Japanese elections in August of this year, there has been much discussion, particularly in the Japanese media, about the foreign policy orientation of the new Democratic Party of Japan (DPJ)-led administration. Some commentators see an “anti-American” tilt—evidenced by differing views on the relocation of U.S. bases in Okinawa and the renewal of Japanese naval refueling operations in the Indian Ocean.

This viewpoint misses the foreign policy forest for its trees. The paradigm-shifting potential of this change lies much more in the DPJ’s desire to re-center Japan’s foreign policy on Asia. Across the spectrum of the DPJ, from former socialists on the left to those who came out of the conservative Liberal Democratio Party (LDP), there is broad agreement on the need to put much greater emphasis on Japan’s ties to the rest of Asia, particularly to China and South Korea.

The new Asianism in Japanese foreign policy was on display at the October 10 triangular summit of the Chinese, South Korean, and Japanese leaders, held in Beijing. It was only the second time these three have met on their own and the meeting was substantive, covering everything from coordinating on North Korea and economic stimulus policy to taking initial steps toward formation of a new East Asian Community. “Until now, we have tended to be too reliant on the United States,” Prime Minister Yukio Hatoyama told reporters after the meeting, adding that “The Japan-U.S. alliance remains important, but as a member of Asia, I would like to develop policies that focus more on Asia.”

The dominant foreign policy camp in Japan has been what Hitoshi Tanaka, a former senior foreign ministry official and close advisor to the DPJ, calls “alliance traditionalists,” whom he defines as those who “place the maintenance of a robust alliance with the United States above all other foreign policy priorities.” In the view of some DPJ policy advisors, the previous conservative governments mistakenly tried to cope with the challenge of a rising China by getting as close to the United States as possible. The decision to send troops to Iraq and the Indian Ocean was prompted not by any deep support for those causes but rather by the belief that this would ensure U.S. support in any tensions with China, and with North Korea.

All this took place as Sino-Japanese relations descended into their most troubled phase in the postwar period, prompted by former Prime Minister Koizumi’s provocative visits to Yasukuni Shrine, which honors Japan’s war dead. High-level contacts with China were frozen, tensions rose over territorial issues in the East China Sea, and rising nationalism on both sides culminated in the outbreak of government-sanctioned anti-Japanese riots in 2005 and a Chinese campaign to block Japan’s permanent membership in the United Nations Security Council.

There was an attempt by Koizumi’s conservative successors to roll back some of these tensions. But those signals were always mixed with the persistence of anti-Chinese views and the powerful camp of rightwing nationalists in and around the LDP who cling to a revisionist view of Japan’s wartime role, some even indulging in a vigorous defense of Japanese imperialism.

In the view of DPJ policy advisers, this pseudo-containment strategy is doomed to failure. Given the increasing economic interdependence between the United States and China, and their overlapping strategic interests, the United States will never form an anti-China front. Japan cannot rely solely, these advisers argue, on the U.S.-Japan security alliance to deal with China’s bid for regional hegemony.

Nor can Japan afford to indulge fantasies of confrontation with China, given its own extensive ties to its economy and society. Rather, the greater threat, in the view of many Japanese analysts, is being abandoned by the United States through the formation of a U.S.-China “Group of Two” that effectively excludes Japan, or relegates it to second-level status in the region.

Japan, those policymakers argue, needs to preempt that threat by engaging Asia on its own—not only China, but the entire region, from India back to Korea. The DPJ’s own policy vision, articulated by Prime Minister Hatoyama, Foreign Minister Katsuya Okada, and party strongman Ichiro Ozawa, remains vaguely defined but has three clear elements:

• The U.S.-Japan security alliance remains the cornerstone, but with limits.
• Japan plays a leadership role in East Asian regionalism.
• The “history” question must be resolved.

What does this mean? There should be little question, particularly after the initial meetings between the new government and the Obama administration, that the DPJ seeks to back away from the security alliance. Over the past fifteen years, the DPJ leadership has not only supported, but even led, the expansion of Japan’s security role, beginning with the passage of the 1992 law permitting Japanese participation
in peacekeeping operations and including the initial dispatch of naval forces to the Indian Ocean in response to 9/11. Though the DPJ has made commitments to reduce the U.S. presence in Okinawa, it is already realizing how difficult that is to accomplish; some kind of compromise on this issue is imminent. Similarly, Foreign Minister Okada’s visit to Afghanistan and Pakistan demonstrated a willingness to contribute, mostly through economic aid, to the security effort in both countries.

Prime Minister Hatoyama presented his somewhat romantic desire to reproduce the European experience to create an East Asian Community in September before the United Nations General Assembly. Hatoyama has indicated that he understands this is a long process, and has been careful to make clear that Japan has no intention of excluding the United States’ role in the region, nor the use of the dollar as a reserve currency. As Hatoyama put in his UN address:

Today, there is no way that Japan can develop without deeply involving itself in Asia and the Pacific region. Reducing the region’s security risks and sharing each other’s economic dynamism based on the principle of “open regionalism” will result in tremendous benefits not only for Japan but also for the region and the international community.

Given the historical circumstances arising from its mistaken actions in the past, Japan has hesitated to play a proactive role in this region. It is my hope that the new Japan can overcome this history and become a “bridge” among the countries of Asia.

I look forward to an East Asian community taking shape as an extension of the accumulated cooperation built up step by step among partners who have the capacity to work together, starting with fields in which we can cooperate—free frade agreements, finance, currency, energy, environment, disaster relief and more. Of course, Rome was not built in a day, so let us seek to move forward steadily on this, even if at a moderate pace.

DPJ policymakers advocate pursuit of an East Asian community as only one of a nest of regional structures, including a regional security system that might grow out of the Six Party talks on North Korea. They also embrace the idea of a Japan-U.S.-China strategic dialogue, based on their own perception that without the combined muscle of the United States and Japan, they cannot bring China to the table on a range of issues from energy to intellectual property.

The last element of the DPJ’s policy vision is to take another major step in clearing away the legacy of the wartime past. Hatoyama personally reaffirmed his government’s adherence to the statement on war responsibility issued by then Prime Minister Murayama in 1995, at the time of the 50th anniversary of the end of the war.

Hatoyama, Ozawa and others in the DPJ leadership are determined to confront the history issue in a way that eases tensions with China and South Korea and also closes doors backward. They will not only refuse to go to the Yasukuni Shrine but also want to remove the Class A war criminals whose “souls” are enshrined there by decision of the shrine authorities, to the consternation of the Emperor, among others. The DPJ led the hue and cry over the unapologetic revisionism of former Japanese air force chief of staff, General Toshio Tamogami, who wrote an essay justifying Japan’s colonialism and wartime aggression, including the attack on Pearl Harbor. Foreign Minister Okada has backed the creation of a joint history textbook by China, Japan and South Korea, based on the model followed by France and Germany. These are stances the LDP has been historically incapable of taking.

The DPJ draws some inspiration from the anti-imperial form of Asianism—“Small Nipponism”—championed by the late Tanzan Ishibashi, who served briefly as premier in the mid-1950s and who was allied to Hatoyama’s beloved grandfather, and former premier, Ichiro Hatoyama.

In the coming months, the Hatoyama government will have numerous opportunities to develop its new policies, particularly in the run-up to Japan’s hosting of the APEC summit next year. Undoubtedly, it will be difficult to implement in practice, but this new Asianism marks a clear turning point in Japan’s postwar foreign policy.